20200423 Ver 1_Shoreline Stabilization_20200330

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/26/2020 4:36:07 PM (Submittal)
Approve by Montalvo, Sheri A 3/30/2020 7:13:40 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 3/26/2020 4:36 PM

Submission Form
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Owner Information:
Name: *
Email:*
Phone Number:*
Mailing Address:*
Is there an agent working on the
project?*
Agent/Consultant Information
Name:*
Company Affiliation:*
Email:
Phone Number:*
Mark Reece
mark.reece@\Aestrock.com
[phone]
(xxx)xxx-xxxx
Street Address
194 Douglas Rd
Address Line 2
City
Elkin
Fbstal / Zip Code
28621-9092
r Yes
r No
Dean Fisher
State / Rovince / Fbgion
NC
Country
us
Lake Norman Custom Dock & Pile Driving, Inc
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:* Street Address
PO Box 1439
Address Line 2
city
State / Rovince / Region
Denver
NC
Fbstal / Zip Code
Country
28037
United States
Asigned and dated copy of the Agent Authorization letter:*
SignedAgentForm.pdf 31.44KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Reece Shoreline
If your project has a formal name please use this. If your project does not ha\,e a formal name, please identify your project by
the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that ha\e been used to identify the project in the past.
1. Provide a vicinity map (i.e. street map) clearly showing the location of the property with respect
to local landmarks such as towns, rivers, and roads.
r Upload File
r Lookup address
Upload Map: Vicinity Map.pdf
Latitude:* 35.583494
74.87KB
Longitude:*-80.996833
2. Provide a detailed site plan showing property boundaries and proposed locations of vegetation clearing,
structures (buildings, retaining walls, docks, impervious surfaces, etc.), rip rap, excavation or dredging
below Full Pond/ Normal Water Level elevations, and construction access corridors. You may use the
diagram under section 12.normal pool lake level/normal water level*
Site Plan.pdf 76.87KB
Please use the diagram atthe link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a
yard stick, shovel handle, etc.)*
shoreline.jpg 86.26KB
shoreline2.jpg 137.22KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Sherrills Ford
County: * Catawba
Subdivisions name or site address:* 4027 Chevlot Hills Rd, Sherrills Ford NC 28673 lot 204
Include phasellot nunber
Directions to site:*

Head northwest on NC-16. Take the NC-1 50 exit toward
Lincolnton/Mooresville. Turn right onto NC-150 E. Turn left onto
Chevlot Hills Rd. Property is on the left.
Rease include road naves and nunbers, landnarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
undeveloped land with grass, trees, and shrubbery.
Residential, undeveloped, etc.
6. Property Size .860
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Grading and installation of rip -rap to prevent further erosion of
shoreline.
8. How will the work be done?* 17 From Land
I— From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
400 sq ft
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
1200 sq ft
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees, for instance)
undeveloped land with grass trees and shrubbery.
Sketch: Site Plan.pdf 76.87KB
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
$240.00 for impacts to lake (below normal water level) of less than 1 acre
$570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions Act")
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
• I intend to electronically sign and submit this form.
Full Name:* Dean Fisher
Signature:
}�

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200423
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
r Yes f No
Version:* 1
Alan Johnson:eads\adjohnson1
Mooresville Regional Office - [phone]
r No Payment Needed
f Fee Received
r Need Fee - send electronic notification
* $240.00
f $570.00

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT N0. 204
PLAN NO. 19-154 PARCEL ID: 460715639286
STREET ADDRESS: 4072 Cheviot Hills Rd, Sherrilis Ford NC 28673
Please print:
Property Owner: Mark Reece
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher of Lake Norman Custom Dock & Pile Driving, Inc
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
194 DOUGLAS RD Elkin NC 28621
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Auth sized Signature Authorized Signature
Date: 2 -/ Z-C) Date:

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